Chronic Pain

 Chronic pain affects 40-50 billion people per year - '86 (30-40 million pts-USA)

3-6 mo best definition but = any pain that lasts longer than normal healing process (musculo-skeletal >

3-4 wks) Sometimes is chronic from day 1.

 Transition Acute - Chronic

1) pain loses its physiologic function

2) abnormal emotion is superimposed; 90% are depressed (starts as anxiety)

3) pain becomes disease entity, itself

4) becomes incurable

 Level Of Care

1) outpt- blocks, usually via anesthesiologist

2) inpt - neurosurgeon, hand surgeon, foot surgeon

3) rehab - physiatrist, therapists

 Type of Prescription

Depends upon staff and ethnic groups being treated. All include physiologic and Cognitive Behavioral

Strategies. Many become severely deconditioned (sedentary) therefore one of the goals is to increase

level of activity, discipline and med intake.

 Principles of Management

1) exercise (work through initial pain) stretch hamstrings and strengthen abdominal muscles

2) functional activity - walking, biking, sitting, standing

3) relaxation (as much as 90% pain = muscle spasm) contrast relaxation, massage, biofeedback,

rhythmic breathing

4) posture and body mechanics

5) behavior modification - positive reenforcement

6) medication

7) activity tolerance

8) family role

9) patient and family education

 Ingredients of Management

1)awareness of problem

2)need to change

3)ability to alter behavior

4)intact "ego" function

5)effective teacher

 Six Disasters

1) disuse

2)depression

3) dependency

4) drugs

5) doctor shopping

6) disability

 10 Commandments for coping with pain

1) my problem

2) no need to fear pain

3) I will do what I really want to do

4) maintain my exercises

5) medication as prescribed

6) no one will know

7)life style adjustment

8) others will not suffer

9) pacing

10) pain will not rule me

 Outcome Measures Used at Spain Rehab Hospital

1) decrease pain intensity

2) decrease pain behavior

3) increase function

4) improved medication

5) satisfactory family reaction

6) RTW (must be < 2 years)

7) abandonment of litigation (actually, very few involved)

Excellent = 5-7 Satisfactory = 3-4

Spain Rehab: Ex = 20%; Satisfactory = 45%; Fair = 35%

 Most Commonly Used Outcome Criteria

1) activity level

2) pain intensity

3) medication

4) health care usage

5) return to work

 Suggested Outcome Criteria

1) return to work or regular activity

2) improvements of medication

3) reduction of health care usage

4) discontinuation of compensation for pain

5) improvement of attitude

6) increase in activity level

 Core of Program

Convince patient that pain and some body impairments do not necessarily prevent satisfactory life.

Back To: Patient_Education